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NURSING
MOTHERS, INC.
Getting Started in Breastfeeding
Factsheet 1
During Pregnancy
1. Talk to your support people about nursing and solicit their help. Let your doctors know you plan to nurse.
2. If you have the option, choose a doctor for
the baby. Arrange an interview visit with the doctor of your choice (you may
have to pay for this visit). Let him or her know you would like to
breastfeed and ask questions to decide how supportive the doctor will be.
a. How do you feel
about breastfeeding?
b. How often
should I nurse my baby?
c. How many months
should I nurse?
d. When do you
recommend introducing solids?
e. Should I
supplement my baby with water or formula?
f. What do you do
if the baby has low blood sugar? Jaundice?
g. How many of
your moms nurse?
h. How do I know
if my baby is getting enough milk?
i.
With whom do I speak when I call with breastfeeding questions?
j. What do you
recommend (usually) if the baby or I get sick?
Look around the office. Do you see pictures of babies nursing, or information displayed for mothers who want to nurse? How prominent is formula company information?
3. No nipple preparation is necessary. However, you might want to expose your nipples to air more frequently prior to delivery. Avoid using soaps or drying agents on your nipples. Glands around the nipples secrete a substance that helps protect and keep them clean during pregnancy and lactation. Rinsing with water is sufficient. You can ask your doctor to examine your nipples to see if they are flat or inverted.
4. Close to delivery you may want to select nursing bras (usually 2-3 will do). Check for proper fit. Bras should provide support without tightness that could cut off milk ducts. Flaps should be easy to open with one hand and should not contain plastic liners that can trap moisture and lead to soreness. Nursing Mothers has bras you can borrow to help you select your proper size or to wear temporarily if you experience engorgement.
5. You can start to put together a "nursing-friendly" wardrobe. Nursing gowns with openings in the seams or nightgowns with front openings down to your waist are nice, but not necessary. Look through your pre-pregnancy clothes for large pullover tops or blouses; these help you nurse discreetly, since they can be raised at the waist or unbuttoned from the bottom. Dark colors and patterns help disguise any leaking that might occur in the first weeks. Elastic waistlines will be more comfortable.
6. If possible, line up help for the first weeks after your baby is born. You will need to take time to rest, recover, and get to know your baby. Ask close friends and relatives if they could help you clean, cook, and shop while you learn to care for your baby. Prepare and freeze meals before the birth.
7. Take this time to learn more about breastfeeding. Attend a breastfeeding class for additional support. Nursing Mothers offers introductory classes the first Thursday of every month. Many excellent books are available to help you learn what you can expect. Nursing Mothers has lending libraries with books of interest.
Labor and Delivery
· Remind doctors and nurses that you plan to nurse so they can help you get started as soon as possible. It is important that you not be given any medication that will either dry up your milk or be harmful to your baby.
· To take advantage of your baby's alertness right after the birth, try to nurse your baby as soon as possible, ideally within the first hour. The first food your baby will receive from you is colostrum, a yellowish substance that precedes your milk. Colostrum is often called "nature's vaccine." It is rich in nutrients, specific immunities your newborn requires, and is easily digested and mildly laxative.
·
Suggestions for the first feeding:
a. Ask for the
baby if she is not offered to you. Get in a comfortable position, sitting
or lying on your side. Use pillows to support your back, knees, and arms,
and to raise the baby to breast-level. Have your baby's head in the crook
of your arm; your hand holds her
bottom or thigh.
b. Using the hand
opposite the breast your baby will nurse on, hold your breast with your
thumb on top and fingers underneath (the "C-hold"). Make sure
your fingers do not cover
your areola (the dark part around the
nipple).
c. Gently touch
your nipple to your baby's lower lip to encourage the baby to open her
mouth. Your baby will probably make nibbling motions. Wait until
her mouth is open
wide, like a yawn, and then hug her onto your breast. It may take a
minute or more for
her to open her mouth wide enough. She should take the entire nipple and
as much of the
areola as she can. Her tongue should extend past her lower gum and cup
the bottom of
your breast.
d. Her nose will
gently touch your breast. You will see the muscles from her jaw up to her
temple moving. You should not feel extreme discomfort if your baby has
latched on
correctly. If you do, break the suction by inserting your little finger
between the breast
and your baby's gums (never pull her off), and try again.
e. Don't worry
about timing your feedings. Let your baby nurse as long as she desires on
the first breast. Watch her for signs that she is done: she falls
asleep or off the breast after
nursing, her active sucking slows, you don't hear her swallowing.
f. When she has
finished nursing on the first breast, you can burp her.
g. You can then
offer her the other breast. If she has "finished the first breast
first", she may nurse briefly or not at all on the second side. This
is fine. Be sure to offer that side first at the next feeding. When
your milk comes in, maintain this pattern. Complete nursing on the first
breast insures your baby gets the important fat-rich milk you produce later in
the
feeding.
h. If you choose
to nurse lying down, you can roll further to the same side to offer the second
breast rather than rolling over to the other side. Support your head,
back, and knees with pillows. Cesarean mothers may find this
technique especially comfortable.
The First Week
As hospital stays get shorter, you may find you have little time to practice nursing while you are in the hospital. Most women leave the hospital before their milk "comes in." During this stressful and sometimes confusing time, try to keep in close contact with your Nursing Mothers counselor and medical care providers. Don't hesitate to ask questions, no matter how silly they might seem to you.
1. Newborns nurse 8 to 12 times in a 24 hours
period. Frequent nursing early on is beneficial for both you and your
baby. Frequent nursing:
a. Allows your
baby to get the important colostrum he needs.
b. Helps prevent
normal breast fullness when your milk comes in from turning into painful
engorgement.
c. Stimulates
contractions to help your uterus return to its pre-pregnancy size and to
help prevent hemorrhaging.
d. Helps prevent
normal newborn jaundice.
e. Stimulates your
milk to come in sooner.
f. Helps
build and stabilize your milk supply to meet your baby's needs.
Try to watch your baby rather than a clock when you nurse. When he cries, offer the breast to see if he is hungry. Do encourage a sleepy baby to nurse every 2-3 hours during the day and at least once during the night. A newborn should not have more than 1 or 2 periods a day when his sleep stretches to 4 or 5 hours.
Through the first weeks, avoid supplementing your
baby's intake, unless your baby's doctor advises otherwise. Colostrum and breastmilk contain
everything your baby needs in exactly the right quantities. Offering
additional water or formula decreases your baby's interest in nursing, which
will lead to a reduction in your milk supply. Using a bottle may also
lead to
nipple preference, a situation where the baby refuses the breast in favor of a
rubber nipple. If you know you will need to bottle- and breastfeed your baby
later, start introducing a bottle after the fourth or fifth week.
Instead of using a pacifier you can let your baby do
his comfort sucking on one of your
well-cleaned fingers. This will also help prevent nipple preference
problems.
2. If
you are a first-time mother, your milk
will usually come in 2-5 days after birth. You may
notice the sensation of let-down. Let-down releases the fatty hind-milk
in the breast and
makes it available for your baby. Signs of a functioning let-down include
a tingling sensation, fullness, leaking from the nipple, change in the shape of
the nipple, or hearing the baby gulp milk. Not all women experience the
characteristic tingling associated with let-down.
Fullness is a
normal experience associated with your milk coming in. Frequent nursing
will
minimize any discomfort. If normal
fullness is not relieved, it can become engorgement.
a. Hand express milk before nursing to soften nipple, if
necessary.
b.
Nurse often to keep milk flowing.
c.
Use breast massage and warm compresses before feeding. This will
stimulate breast
tissue and improve milk flow.
d.
Cool compresses after feedings can reduce swelling.
e.
You may find warm showers, with water running over your shoulders from your
back onto your breasts soothing.
3. 50-70% of all newborns experience normal
newborn jaundice. Jaundice is
usually not
dangerous and is rarely a reason to wean. The best preventative for
normal newborn jaundice is frequent nursing. Some doctors may recommend
taking the baby off the breast for several feedings to evaluate the cause of
your baby's jaundice. If your doctor prescribes supplements, ask if you
can breastfeed first and then supplement. If you must temporarily stop
breastfeeding, express your milk manually or with a good electric breast pump
whenever you feed your baby.
4. Night feedings are a part of every mother's experience. They are particularly important to the breastfeeding mother, as they help build the milk supply. Make them business-like so you can go back to sleep quickly to get your needed rest. Many women find keeping their babies in bed with them allows them to nurse and rest.
Life with Baby
When a child enters your life, you enter a period of adjustment as your lifestyle accommodates the change. Now is a time to relax your expectations, seek support, and make choices that simplify your life. Your most important job is taking care of yourself and your baby!
1. Recuperate!
You need to eat well, drink clear fluids to thirst, and get plenty of
rest. Eating
smaller meals more frequently through the day helps sustain your energy.
Each time you
nurse, have something to drink nearby. Try to sleep whenever the baby
sleeps.
2. You
may experience leaking before your let-down reflex becomes
well-established. Leaking usually subsides after several weeks.
a. Insert
absorbent cotton fabric, a handkerchief, or nursing pads (washable or
disposable without plastic backing) in your bra. Change them frequently
as they become wet.
b. Sterilized dropcatcher can be used to save milk leaked from the second
breast while
baby is nursing on the first. Be sure to position the hole on top.
Promptly refrigerate or freeze the milk.
c. You can stop
unwanted leaking between feedings by pressing down flat on your nipples with
your palms, wrists or crossed arms.
d. blis, a plastic that fits discreetly in your bra, provides gentle pressure that can stop leaking.
3. Most doctors recommend that you continue your prenatal vitamins while you are lactating.
4. Emotional
ups and downs for the first few months are common. They are due in part
to
hormonal fluctuations and the tremendous changes taking place in your
life. It is perfectly
normal to have mixed feelings about parenthood. If you feel completely
overwhelmed by
your emotions, do not hesitate to seek professional advice.
5. Sexual
adjustments usually take time. Try to plan intercourse for times when
your baby is
unlikely to awaken for feeding and when you are not fatigued. Intercourse
may be
uncomfortable at first, due to a tender episiotomy and/or a lack of vaginal
secretions as a
result of lactation hormones. Try using different positions to remove
pressure from the healed incision. KY jelly or its equivalent can provide
lubrication. Place a towel underneath you to absorb any milk that might
leak.
Breastfeeding is not always a safe form of
contraception. Discuss
birth control options with your doctor.
6. Newborns
commonly have 1 or 2 periods of long sleep (4 to 5 hours) balanced by 1 or 2
fussy periods each day (sometimes lasting several hours). The amount of
sleep babies need
varies greatly. Some sleep 20 out of 24 hours, while others sleep much
less. Your baby's
sleep patterns will change as she grows and gets accustomed to the family
schedule.
7. Most babies experience "growth spurts", or periods when their need to nurse increases. It is not unusual during this time for a baby to request very frequent nursings -- sometimes every hour or 1 1/2 hours. By feeding your baby as often as she needs, your milk supply adjusts. These periods of increased nursing usually last only 2 to 3 days, after which time your milk supply has increased to meet your baby's growing requirements. You may also notice increased nursing after a particularly busy day. During this period, it is a good idea to increase your fluid intake and get additional rest.
8. If you know you will be returning to work after your baby is born, now is the time to develop a strategy for nursing and working. Many women successfully work and continue nursing. Some mothers can pump breastmilk at work and save it for later feedings, while other mothers choose to breastfeed at home and formula-feed when they work. A Nursing Mothers counselor can help you decide on a schedule to suit your needs. Several weeks before you return to work, it is a good idea to gradually adopt the schedule you will use when working.
Common Concerns
1. "Is
my baby getting enough milk?" You can never know exactly how
much milk your
baby is taking from you, but these signs indicate she is getting enough:
a. Your newborn nurses 8-12 times in a 24 hours period.
b. After your milk
"comes in", your newborn has one or more bowel movements in a 24
hour period.
c. Your newborn
has 6-8 wet diapers in a 24-hour period.
d. You can hear
your baby swallowing while she nurses.
e. In the first 4
to 6 weeks, your breasts feel softer after nursing. When your milk supply
stabilizes, your breasts will feel
soft most of the time.
f. Your baby is
alert and filling out.
g. Your baby
nurses as long as she wants until she lets go of the breast and is finished.
h. Your baby is
not overly sleepy, and does not sleep more than 4 to 5 hours twice a day.
2. "What should I eat?" You should eat a well-balanced diet, choosing appropriate quantities from all the food groups. Don't avoid certain foods unless you begin to notice a problem. If you do notice a connection between a particular food and gas in your baby, try to limit or temporarily eliminate that food from your diet. Babies usually outgrow their sensitivity over time, so try reintroducing the food occasionally. See Factsheet #13 on Nutrition and Factsheet #10 on When Baby Cries for more information.
3. "What are normal bowel movements?" Most newborns average 2-5 stools in a 24 hours period for the first weeks. Stools of breastfed babies are soft and fluid, greenish or the color of mustard, and sometimes seedy-looking. During the first week, the color changes from black to brown to yellow or green. Sometimes the stool may only stain the diaper. It is normal for some babies to strain when having a bowel movement; constipation in breastfed babies is extremely rare. In older infants, bowel movements vary from baby to baby and from month to month in the same baby. Some babies have movements with every feeding, while others can go for 10 days without a stool.
Special Notes
1. While lactating, you should consult your baby's doctor or a registered pharmacist before taking any medication, even over-the-counter drugs. Make sure medications are nursing-safe. Some medication can harm your baby, while others can quickly decrease your milk supply.
2. Dieting
can affect your milk supply. A lactating woman should lose no more than 1
pound
every 1 to 2 weeks. Fad or crash diets are not recommended. Consult
your doctor about
moderate exercise plans and modifications to your diet.
Related Fact
Sheets
Managing Normal Breast Fullness and Engorgement
Signs Your Baby is Getting Enough
Difficulty Grasping the Nipple or Nipple Preference
CPM, March 1986
Rev. 10/90; Rev. 10/94 LD; 1/03 Megan Allen
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